I. Field of the Invention
The invention relates to a surgical instrument for making a space for receiving a larynx prosthesis.
II. Description of the Prior Art
When a cancer is found in the region of the larynx, the cancer is removed, sometimes together with parts of the air pipes and the alimentary passage, whereafter an air intake and discharge opening (tracheostoma) is formed in the neck. In order to provide the patient with the facility for speech, a connecting passage, which may be referred to as a shunt passage, is formed between the tracheostoma and the alimentary passage, after it has been ensured that mucous membrane folds which are capable of vibrating are to be found above the shunt passage in what remains of the alimentary passage, or the substitute therefor. The shunt passage serves as a space for receiving a larynx prosthesis which may comprise a pipe with a cap-like end and a slot disposed therein, to act as a valve. By closing the tracheostoma, the patient can pass respiration air by way of the larynx prosthesis into the alimentary passage and the mouth-throat cavity, which enables him to achieve natural speech relatively quickly or after some practice.
Hitherto, the instrument used for making the shunt passage for the larynx prosthesis has been a puncture needle with which a puncture is made from the tracheostoma to the alimentary passage, whereupon a vein catheter is passed through the puncture needle and taken through the nose, by means of an oesenoesophagoscope. A hose or tube is pulled through with the vein catheter, the hose being passed through the punctured passage and through the nose and the ends thereof being knotted together. It is possible to use a tube like puncture needle having a passage for pulling through a thread, such needle being referred to as a Braunule instrument.
A further known operating technique is cutting with a pointed scalpel towards a blind fitted rubber catheter, whereupon a hose is fitted into the cut (shunt), as a place holder.
For reasons of voice formation and in order to avoid leakage air passing into the stomach, it is desirable for the larynx prosthesis not to face downwardly with its slotted end. Such a positioning is achieved with the operating technique first referred to above, because, during the healing process, the hose which is introduced plays the part of a place holder for the larynx prosthesis and does not have any downward tendency. A disadvantage however is that the hose which is passed through the mouth cavity and the hose has a detrimental effect on the patient (traumatisation, a nuisance and a strain during the healing process, and dysphagia).